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Butrans
Butrans is a transdermal patch that delivers buprenorphine, a partial opioid agonist, used for the management of moderate to severe chronic pain in patients who require continuous, around-the-clock opioid analgesia for an extended period. Buprenorphine works by binding to opioid receptors in the brain to reduce the perception of pain. Butrans is not intended for use as an as-needed (prn) pain reliever or for acute pain.
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Frequently Asked Questions
How long does it take for Butrans to start working?
The effects of Butrans begin within a few hours after the patch is applied, but full pain relief may take a day or two to be felt.
Can I shower or swim with the Butrans patch on?
Yes, the Butrans patch is designed to stay on during normal daily activities, including showering, bathing, and swimming. However, excessive exposure to water or vigorous activity may cause the patch to loosen.
What should I do if the Butrans patch falls off?
If the patch falls off before 7 days, apply a new one to a different skin site. Contact your healthcare provider if patches continue to fall off frequently.
Can Butrans cause withdrawal symptoms if stopped abruptly?
Yes, stopping Butrans suddenly can cause withdrawal symptoms. Always consult your healthcare provider before discontinuing the medication and follow a tapering plan if necessary.
Is Butrans safe for long-term use?
Butrans is approved for long-term management of chronic pain, but it carries risks of addiction, dependence, and overdose. Patients should be regularly monitored for signs of misuse or adverse effects.
Comprehensive Drug Guide
How Does Butrans Work?
Buprenorphine, the active ingredient in Butrans, works by binding to the mu-opioid receptors in the central nervous system. As a partial agonist, it produces analgesia and euphoria but has a ceiling effect, which limits the extent of these effects and reduces the risk of respiratory depression compared to full opioid agonists. This makes it useful for long-term pain management with a lower risk of overdose.
What is Butrans Used For?
Management of Chronic Pain: In patients who need continuous, long-term opioid treatment and for whom alternative treatment options are inadequate.
Common Dosages
Butrans is available by prescription only and is classified as a Schedule III controlled substance in the United States. It is available as a transdermal patch in different strengths that release buprenorphine over 7 days.
Administration: The Butrans patch is applied to the skin once every 7 days. It should be placed on a flat, hairless area on the upper outer arm, upper chest, upper back, or the side of the chest. The patch should be pressed firmly in place for 15-30 seconds to ensure adhesion.
Duration of Use: Butrans is used for long-term pain management. Patches are changed every 7 days, and the application site should be rotated to avoid skin irritation.
Typical Dosing
FDA Approved Indications
Butrans is available in multiple dosage strengths that release different amounts of buprenorphine over 7 days:
- 5 mcg/hour
- 7.5 mcg/hour
- 10 mcg/hour
- 15 mcg/hour
- 20 mcg/hour
The dosage is individualized based on the patient's level of pain and opioid tolerance, with the lowest effective dose being used.
Who Shouldn't Take Butrans?
Butrans is contraindicated in patients with:
- Severe respiratory depression or significant respiratory compromise.
- Acute or severe bronchial asthma in an unmonitored setting.
- Known hypersensitivity to buprenorphine or any components of the patch.
- Paralytic ileus (bowel obstruction).
Advice From The Pharmacist
Patients using Butrans should be advised to:
- Apply the patch to clean, dry, and hairless skin. Avoid placing it on irritated or damaged skin, and rotate the application site each week.
- Keep the patch away from heat sources, as heat can increase the release of buprenorphine, potentially leading to overdose.
- Be cautious about side effects such as drowsiness, dizziness, or impaired thinking, and avoid driving or operating heavy machinery until they know how the medication affects them.
- Dispose of used patches properly by folding them in half (sticky sides together) and placing them in the provided patch disposal unit or flushing them down the toilet if no disposal unit is provided.
- Avoid cutting or damaging the patch, as this can alter the release rate of the medication and lead to overdose.
Side Effects of Butrans
Common Side Effects
- Nausea or vomiting
- Constipation
- Dizziness or lightheadedness
- Headache
- Itching, redness, or irritation at the patch site
- Dry mouth
Uncommon/Severe Side Effects
- Respiratory Depression: Difficulty breathing or shallow breathing, especially during sleep or after dose increases.
- Severe Hypotension: Sudden drops in blood pressure leading to fainting or dizziness.
- Addiction, Abuse, and Misuse: Even though Butrans has a lower risk compared to full agonists, misuse can still lead to addiction or overdose.
- Serotonin Syndrome: Symptoms include confusion, agitation, rapid heart rate, and hallucinations, especially when used with certain antidepressants.
Risks and Warnings of Butrans
Risk of Overdose: Heat exposure (e.g., heating pads, hot baths, fever) can increase the release of buprenorphine from the patch and lead to overdose.
Addiction and Dependence: Buprenorphine is an opioid, and there is a risk of addiction and dependence, even at prescribed doses.
Respiratory Depression: Opioids, including buprenorphine, can cause life-threatening respiratory depression, especially in the elderly or in patients with existing respiratory issues.
Withdrawal Symptoms: Abrupt discontinuation of Butrans can lead to withdrawal symptoms such as nausea, sweating, restlessness, and anxiety. The dosage should be tapered gradually under medical supervision.
Interactions with Butrans
Common Drug Interactions
Butrans may interact with other medications, including:
- Benzodiazepines and Other CNS Depressants: Such as alcohol, sedatives, or muscle relaxants, which can increase the risk of sedation, respiratory depression, or overdose.
- MAO Inhibitors: Concomitant use can lead to dangerous interactions.
- Antidepressants (SSRIs, SNRIs): May increase the risk of serotonin syndrome.
- CYP3A4 Inhibitors: Such as ketoconazole, which can increase buprenorphine levels and the risk of side effects.
Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.
Alternatives to Butrans
Alternative pain management options include:
- Other Opioid Medications: Such as oxycodone or morphine for long-term pain control.
- Non-Opioid Pain Relievers: Such as acetaminophen, NSAIDs, or gabapentinoids.
- Long-Acting Opioid Formulations: Such as fentanyl patches.
- Non-Pharmacological Pain Management: Such as physical therapy, acupuncture, or nerve blocks.
The choice of treatment depends on the severity of pain, the patient’s opioid tolerance, and the response to previous treatments.
